Perspectives in Biology and Medicine最新文献

Many factors determine whether and when a class of therapeutic agents will be successfully developed and brought to market, and historians of science, entrepreneurs, drug developers, and clinicians should be interested in accounts of both successes and failures. Successes induce many participants and observers to document them, whereas failed efforts are often lost to history, in part because involved parties are typically unmotivated to document their failures. The GLP-1 class of drugs for diabetes and obesity have emerged over the past decade as clinical and financial blockbusters, perhaps soon becoming the highest single source of revenue for the pharmaceutical industry (Berk 2023). In that context, it is instructive to tell the story of the first commercial effort to develop this class of drugs for metabolic disease, and how, despite remarkable early success, the work was abandoned in 1990. Told by a key participant in the effort, this story documents history that would otherwise be lost and suggests a number of lessons about drug development that remain relevant today.

The consequences of experiences and exposures suffered by those living in poverty can last a lifetime and can even be passed on to the next generation. The challenges associated with poverty have been labeled the "social determinants of health" (SDoH), but this is something of a misnomer. A more appropriate label would be the "social determinants of disease." This essay is a broad overview of the processes, including allostatic load and epigenetic aging, that might contribute to prolonging the adverse effects of the social determinants of disease.

This article explores three different comics by creators with brain tumors: Rick, written and drawn by Gordon Shaw; Going Remote, written by Adam Bessie and drawn by Peter Glanting; and Parenthesis, written and drawn by Élodie Durand. It examines how the affordances of the comics medium enables the creators to present an experience of subjective time that is multiple, diffuse, and contradictory, in contrast to the regular apportioning of time via calendars, schedules, and pathways essential to institutional neuro-oncology. The question of time here is significant because the side effects of brain tumors can include blackouts, seizures, and periods of extreme fatigue, during which the experience of time can be significantly disrupted. The title of the article therefore evokes a temporal duality: on the one hand, it refers to the common phrase used to describe what clocks do, as well as our ability to read them; on the other hand, it speaks to one of the most important qualities of graphic medicine, which is that it allows patients dealing with medical or health issues to tell time differently. The article explores the representation of personal time in Rick, social time in Going Remote, and lost time in Parenthesis.

This essay explores how the authors' curatorial process has roots in wonder: how it is one of inquiry, beginning and ending with open questions. The authors describe how their "crip" curatorial methods can be used to refuse extractive practices that might result from a disengaged wonder and to generate exhibitions that hold both the viewers and the artists with the care necessary to move passive viewing into a reciprocal engagement that can lead to an activist turn. These curatorial methods acknowledge and embrace medical professionals as potentially fellow disabled people and view them as current or potential allies. Through the participatory nature of the art in the exhibitions, the gallery becomes a space of encounter, one that creates support structures for people to build out from their individual, personal experiences and to become part of something shared across people, objects, memory, and experience. However, this shared space is not intended to collapse into ever fully knowing or understanding another person's experience. Critically, it is also a shared engagement where access to someone else's story, or body, or memories is not freely granted. Crip curation takes seriously the intentional omissions of both viewers and artists that upend not only what we get to know but how we get to know it and emphasizes that what we get to know and how we know it necessarily remains incomplete; viewers and artists alone retain full access to their own experiences.

With reference to imagery from Matthias Grünewald's masterpiece, the Isenheim Altarpiece, this essay considers how health-care practitioners especially- but all of us in practice-can learn to wonder in a way that does not objectify the differently abled but instead honors them. Wondering at the images in Grünewald's work requires humility, curiosity, patience, compassion, and grit-virtues that all health-care professionals would do well to cultivate.

History shows alarming shifts in the way that people with intellectual disabilities have been regarded. Locke doubted whether they could be counted among the human, while Rousseau hailed them as unspoiled children who could help us be better; the eugenicists despised them as perpetuating "feeble-mindedness," while the religious praised them as holy innocents. Throughout, however, they have been seen metaphorically, as symbolic figures who incite hatred or inspire wonder, but rarely as real people. This article, written by the father of a young man with severe disabilities, rejects such thinking. The author explains how intellectual disabilities work as a Brechtian "alienation effect" and challenge our core system of values and explores how they make us reconsider much of what we take for granted.

This paper examines the concept and moral significance of "childhood interests." This concept is important in medical decision-making for children and more broadly in the field of pediatric ethics. The authors argue that childhood interests are identifiable components of childhood well-being that carry moral weight. Parents have a special role in protecting and promoting these interests and special obligations to do so. These parental obligations are grounded by the independent interests of the child, as well as the good of society more generally. Because parents have these child-rearing obligations, they must also have the authority and wide discretion necessary to fulfill them. However, while parental discretion is wide, it is not unlimited, for it must be used to safeguard and advance childhood interests.

This article describes the process engaged by 17 expert scholars in the development of a set of six consensus recommendations about the normative foundations of pediatric decision-making. The process began with a robust pre-reading assignment, followed by three days of in-person symposium discussions that resulted in a publication in Pediatrics entitled "Pediatric Decision-Making: Consensus Recommendations" (Salter et al. 2023). This article next compares the six recommendations to existing statements about pediatric decision-making (specifically those developed by the American Academy of Pediatrics), highlighting similarities and differences. Finally, the article discusses the value of finding consensus in the field of pediatric bioethics.

This essay reflects on occasions when images of the author's body stirred wonder and challenged the author's understanding of her relationship to her body. Wonder is not a sentimental or romantic feeling, but an intermingling of both admiration and fear. Wonder is perhaps closest to awe, which has connotations of both reverence and terror. Wonder holds together both the negative and positive emotions that awe once elicited. Finding wonder in your own body, therefore, can be both a fearful and exhilarating experience, one that demands a kind of reconstitution of the self, since the body that was once taken for granted has now become alien.

"First, do no harm" has been cited so often as the fundamental principle of medical ethics that the entailed harm appears self-evident: intentional or unintentional physical harm. This article makes a case for a different kind of harm that physicians can commit against patients: metaphysically harming them by reducing them to mere objects to be fixed or manipulated, instead of persons to be known. Drawing on the history of medicine, theological reflection, and clinical practice, the author compares two ways of regarding the patient: (1) the medical dissective gaze, which knows the patient by mentally cutting her up and reducing her into parts; and (2) iconic perception, which encounters the patient as a living icon. While the medical dissective gaze describes an important dimension to scientific medicine, treating a patient purely as a medical object defaces her human personhood. To address and prevent these kinds of harms, the author proposes that regarding the patient with iconic perception fosters wonder and reaffirms the patient's humanity.